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About reinstating and stabilizing to reduce withdrawal symptoms


Altostrata

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ADMIN NOTE This topic is a general discussion of the principle of reinstatement. For case-by-case consideration of what YOU should do, please put your questions in an Introductions topic.
 
Do not put those questions in this topic, because detailed discussion of YOUR particular circumstances will take it off track and make this topic difficult for others to follow. The moderators will move any questions about YOUR particular case to the Introductions forum. Thank you.
 
Also see

Stabilizing, what does that mean? How long does it take after reinstating or updosing?

Stabilizing after a reduction -- what does that mean?


 

Don't suddenly go off a psychiatric drug assuming that reinstatement is a safety net

 

This is one of the reasons we advocate gradual tapering to minimize withdrawal symptoms. Once the nervous system is destabilized by withdrawal, all bets are off. Humpty Dumpty the egg has fallen off the wall. Sometimes reinstatement does not work. Tapering carefully to avoid withdrawal symptoms is a much safer approach. 

 

What is reinstatement?

Reinstatement means resuming the drug or its equivalent when withdrawal symptoms appear.

 

According to what medicine knows about psychiatric drug withdrawal syndrome, reinstatement is the only way to alleviate withdrawal symptoms. All the papers about withdrawal symptoms allude to how symptoms usually resolve after reinstatement. This is considered a hallmark of withdrawal syndrome.


The inserts in all the newer antidepressants and many other psychiatric drugs advise reinstatement if withdrawal symptoms appear. This is all medicine knows about how to treat withdrawal.

 

Some papers recommend resuming a partial dose of the drug rather than a full dose. A partial dose may be sufficient to stop withdrawal symptoms. See below for discussion.

What we have learned about reinstatement
From what we've learned from patient experience here and other online support sites:

 

  • Reinstatement is best done immediately upon appearance of withdrawal symptoms. The more time that passes, finding the right dose for reinstatement can be complicated.
  • The length of this window of opportunity is unknown, it varies according to the individual. Sometimes people can reinstate successfully months or years after quitting.
  • Minimize risk of kindling, start low to see what you need. You can always increase if necessary. We advise to initiate reinstatement at a very low dose; we also advise carefully monitoring the result and adjusting the dose accordingly. Do not start at a high dose, your nervous system may be sensitized by withdrawal and you may react badly to it even though it's your regular dose. This is called kindling -- see a fuller explanation here.
  • Often a very low dose will relieve withdrawal symptoms. We have seen that often reinstating a very low dose of the drug -- such as 1mg fluoxetine or 1mg escitalopram for someone having gone off 20mg -- is enough to reduce withdrawal symptoms and allow the nervous system to gradually settle down.

    Sometimes it takes a higher dose to address withdrawal symptoms, but going up in dose gradually reduces the risk of kindling from a sudden introduction of a higher dose.

    If, for example, you were taking 20mg Paxil and quit rapidly or cold-turkeyed only a few days ago, a reinstatement of 5mg may be enough. After trying the lower dose for a week, you can always increase if you feel you need more. If you've been off the drug longer, your nervous system may be sensitized and it may be wiser to try a sample dose, such as 0.5mg-1mg to start, to see how you react.
  • You may be able to reinstate an equivalent drug. Some drugs are siblings, such as citalopram and escilatopram or venlafaxine and deslavenfaxine. Fluoxetine, which is arguably easier to taper than other SSRIs, is often substituted for SSRIs such as paroxetine or sertraline. (Paroxetine is so difficult to taper, if you've gone off it, you may prefer to reinstate fluoxetine or citalopram instead.) If you have had a prior adverse reaction to a particular drug, it may be best not to try it as a substitute.
  • Cold turkey is not a shortcut to a lower reinstatement dose

 

Additional reasons to reinstate only a low dose
Reinstating at a low dose reduces the risk of severe adverse drug reactions.

  • Experiencing withdrawal may have sensitized you to drugs and a larger dose or even your usual dose may cause an outsized adverse reaction (kindling).
  • If you had adverse effects while you were taking the drug and now have withdrawal symptoms, a low dose may reduce the withdrawal symptoms without triggering the adverse effects. Adverse effects tend to be dosage-related: The higher the dose, the worse the adverse reaction.
  • These drugs are vastly more powerful than they need to be. Often reinstatement at half dosage is sufficient (many people might have done well from the start with much lower dosage).
  • Your receptors may have adjusted somewhat (upregulated) during the time you were tapering or had withdrawal symptoms and they don't need as much drug to return to their prior homeostasis. See Shapiro, 2018. Subtherapeutic doses of SSRI antidepressants demonstrate considerable serotonin transporter occupancy: implications for tapering SSRIs
  • You can always adjust the dosage upward if you find you need to. After reinstatement, most drugs take at least a week to reach full effect, and often withdrawal symptoms continue to improve after that.
  • If you stabilize on the LOWEST EFFECTIVE dose that reduces your withdrawal symptoms, you'll have less drug to taper when you finally do go off.

 

How long should you give reinstatement?

  • Do not expect immediate elimination of withdrawal symptoms. Though this sometimes does happen, often people feel a little better after reinstatement and then continue to gradually improve over weeks and months after that. Your nervous system has been through a lot and needs to settle down.
  • If you have an immediate bad reaction to the drug -- not continuing withdrawal symptoms -- reduce or stop taking the drug.
  • Observe your symptom pattern for at least a week (unless you have an immediate bad reaction) to see if the reinstatement is helping. It takes about that long for your body to fully register the addition of most short half-life neuroactive drugs. Often, if reinstatement is working, people gradually will feel better as that small drug crutch helps the nervous system to go back to its natural tendency to stabilize over time.
  • A slight immediate improvement is a good sign, this probably will progress as the drug ramps up to steady-state over a week and this support assists your nervous system to settle down. Reinstatement may not immediately eliminate all withdrawal symptoms. It takes time to stabilize, you may still experience waves of symptoms, which usually lessen as time goes on.
  • After reinstatement, time to stabilize on the drug varies according to the individual. Relief can be felt immediately, or after some weeks, or after some months.
  • Be cautious about dosage increases -- more is not always better! Your system has gotten a shock and may react badly (kindling) if you jump to "normal" drug dosages. Give your nervous system time to settle down, be patient after you reinstate, do not leap to increase the dosage. Wait until you see the full effect of the reinstatement before you make an increase -- and then make only very gradual increases.
  • Think in terms of months before you attempt to taper again. Once you feel withdrawal symptoms are milder after reinstatement, give your nervous system time to stabilize before attempting dosage reduction. Do not attempt to taper again until you feel symptom-free, or at least until your symptoms are very mild, predictable, and tolerable.

 

When to discontinue reinstatement

  • If, upon reinstatement, you very soon feel significantly worse after a dose, you may be sensitized to the drug and need to take a smaller dosage or possibly none at all. You will need to observe your daily symptom pattern to see if it's the drug causing your symptoms or if you're having waves of withdrawal symptoms, which are intermittent. If you are reacting to the drug dose, more intense symptoms will occur in a regular pattern -- worse every day shortly after you take the drug.
  • You get a known adverse reaction from the drug. Look up your drug at drugs.com to identify known adverse reactions! A rash is always a bad sign. Sometimes an adverse reaction can be eliminated by taking a lower dosage. Do not mistake an adverse reaction for your existing withdrawal symptoms!
  • Sometimes reinstatement does not work. This often happens when people reinstate a dosage that's TOO HIGH. Their nervous systems have been sensitized from withdrawal and cannot tolerate that much drug effect, tending to kindling. Or, it can happen that people have been so sensitized from going on and off drugs that they cannot tolerate any drugs until their nervous systems settle down.
  • If you have an immediate severe bad reaction after your dose, reduce or stop taking the drug

 

Reinstate at what dosage?
Sometimes reinstatement not only doesn't work but makes symptoms worse -- this is called kindling. That is one reason we suggest trial reinstatement at very, very low doses -- to reduce this risk. Higher doses can go wrong in much bigger ways. Adverse drug effects tend to be dosage-related: The higher the dose, the worse the adverse reaction. Starting at a very low dose is a way to explore reinstatement with less risk.
 
What dosage to reinstate is always going to be a guess. Here are some factors contributing to the decision:

  • How long you've been off the drug. If you've just cold-turkeyed 20mg Celexa a few days ago, you might reinstate closer to your original dosage, such as 10mg. (It may not be necessary to go back to 20mg, standard dosages tend to be overly powerful.) Cold turkey is not a shortcut to a lower dose, you may get stuck in severe withdrawal.
  • If your system has been sensitized by going on and off drugs. If you've had a long history of adverse drug effects or withdrawal symptoms, and you've now had withdrawal symptoms for weeks, your nervous system is likely hypersensitive from destabilization. For example, if you had been taking 20mg Celexa, you might wish to try reinstating at a lower dosage, such as 0.5mg-1mg. It may seem incredible, but these tiny doses are often sufficient to reduce withdrawal symptoms. You can always increase later.
  • If you have symptoms of hyper-reactivity or alerting (anxiety, panic, sleeplessness), you may be too sensitive for reinstatement. If you want to try it anyway, you might wish to try reinstating at a very low dosage, such as 0.5m-1mg if you had been taking 20mg Celexa, for example.
  • How long you've been off the drug. If you've been off the drug for many months, reinstatement is less likely to work. If you want to try it anyway, you might wish to try reinstating at a very low dosage, such as 0.5mg if you had been taking 20mg Celexa, for example, or other SSRIs with a standard dosage of 20mg.
  • Other drugs you're taking. Be very careful adding a drug to other drugs. Use the Drug Interactions Checker before even considering this. (Your symptoms may be due to drug-drug interactions.)

 

None of the above are hard-and-fast rules. There is a lot that's unknown about withdrawal syndrome and how to treat it. There are reports of people with prolonged post-withdrawal syndrome who did better taking a drug at full dosage 2 years later. If you want to do this, please consult a doctor, we cannot advise you on it, your prescriber is going to have to monitor your reaction to the drug.

 

How about substituting another drug for reinstatement? (Especially for paroxetine)

It is preferable to reinstate the drug that caused the withdrawal symptoms rather than another drug, the same drug is more likely to stop the symptoms.

 

But In some situations, you may want to substitute another drug. For example, paroxetine (Paxil) stands out as being very difficult to taper. It is so difficult, that if you went off paroxetine and you want to try reinstatement, you might not want to go back on paroxetine. You may wish to utilize a very low dose of another SSRI, such as fluoxetine or citalopram. Fluoxetine and citalopram are most often used as substitutes; fluoxetine has a long half-life, which may make tapering easier (but correspondingly, any adverse drug effects may also last longer), while citalopram's half-life is only a little longer than the other SSRIs.

 

Milligram for milligram, escilatopram is several times stronger than its close chemical sibling citalopram. If you've gone off escitalopram and always felt it was too strong for you, you may wish to reinstate with citalopram instead.

 

We always urge attempting reinstatement of a very low dose initially, such as 1mg-2mg, to limit adverse reactions, in case the new drug doesn't agree with you. In the US, the SSRIs come in prescription liquid form for easy titration.


About benzo reinstatement

http://www.benzosupport.org/notes_on_reinstatement.htm

 


 

ADMIN NOTE:  Useful Excerpts from the thread

 

NZ11 in post 74https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/?tab=comments#comment-120338

 

Alto in post 75, additional explanationhttp://survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/?do=findComment&comment=120438

 

Alto on Hypersensitivity:  Reinstatement is more likely to work if done fairly soon after stopping a drug, while the nervous system is still somewhat shaped around the drug that's been removed. The window of opportunity is not definitely a month, and probably varies from individual to individual, but reinstatement is best done sooner rather than later. 

 

This makes waiting to see if withdrawal symptoms will go away a difficult choice. If you wait, they may go away or you may miss your chance for effective reinstatement. (Medicine assumes withdrawal symptoms last only a few weeks; it's a sign you're in for a longer period of recovery if your symptoms have not diminished over this amount of time.) 

 

A while after discontinuation, the nervous system changes and may no longer accept reinstatement of the drug to repair the withdrawal reaction. It's like a series of dominoes gradually falling over time. Hypersensitivity can set in making reinstatement very difficult, as the nervous system will react in strange ways to the original drug and often other drugs as well. 

 

(A combination of Celexa with trazodone and nortriptyline can result in serotonin syndrome in anyone. If one's nervous system has been sensitized by withdrawal syndrome, this can cause disastrous adverse effects.) 

 

This is why when someone has been off the drug for more than a month, we suggest trying a very low dose. Hypersensitization is so common with withdrawal syndrome, trying a very low dose initially reduces the risk of a severe adverse reaction. And quite frequently, a very low dose will work to reduce withdrawal symptoms.

 

Edited by Altostrata
updated

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 4 months later...

So I just read the post on stabilizing...

 

"Most people are stable on psychotropic medications before their first taper, so there are no withdrawal symptoms. Holding helps to stabilize withdrawal symptoms that are acquired while tapering, going off CT, etc."

 

My issue is that I haven't been stable like this for three years. The meds have stopped working and I believe I have been in some kind of withdrawal while still on meds. This the whole notion of tapering didnt make any real sense to me.

Started on Zoloft in 2002
Switched to Lexapro in 2005
Switched to Prozac in 2008
Off Prozac abruptly in 2010 (a mistake) - crashed
Lexapro end of 2010 - didn't work
Effexor until 2012 - roller coaster from hell
Back to Prozac November 2012 - one last rise and fall
Quit Prozac 01/13

Reinstated Prozac 5mg 05/13
Trial of 7.5 Remeron for one month 06/13, then off

Off Lamictal 06/13

Quit benzos 06/13

 

Reduced to 4mg Prozac 8/15/13

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  • Administrator

Sorry for the confusion, cmusic's question was answered in his topic http://survivingantidepressants.org/index.php?/topic/3677-cmusic-a-long-history-and-finally-saying-enough/page__p__42103#entry42103

 

If your symptoms have gotten worse, that's a sign the Prozac was doing something. A higher dose might have made you worse, but a very low dose might help the withdrawal symptoms.

 

Low-dose reinstatement may reduce the withdrawal symptoms experienced after quitting. These would be new symptoms different from the adverse effects of the drug while you were taking a full dose.

 

"Stabilizing" as we use it means reducing withdrawal symptoms. It doesn't mean resolving whatever problems you might have had before going on the drug, or returning you to a perfect state of mind or body. Sometimes reinstatement works only slightly -- at least that's better dealing with the full force of withdrawal symptoms.

 

And, unfortunately, sometimes it does not help at all.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 1 month later...

My little experience: Jumped off Zyprexa 12/29/12 after a few months taper (don't remember the start...no idea it would matter). Mostly was on Zyprexa 5mg, jumped off at about 0.6 mg. tried a dose of 0.2mg 4/713. Slept too much, missed a work deadline, totally sedated, screaming at my husband (I know those 2 shouldn't go together). And the nausea that I was trying to stop re-emerged at 11 a.m. But otherwise it went well :).

1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.

Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12

Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13

Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15

11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)

9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol

7.4.14 Started Walsh Protocol

56 years old

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Some people get over withdrawal symptoms such as the brain zaps, and some people get worse for a long time. We don't believe in trying to tough it out when you get severe symptoms.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 7 months later...

Sorry if I missed a thread that explains this, but why does reinstatement only work within one month of stopping or reducing the dose of a drug? What happens if it is reinstated later?  I'm curious if this explains why I developed serotonin syndrome when I took Celexa- to the point of having to stop it immediately. I had taken Celexa earlier in my life with no problems, but I wasn't on the trazodone and nortriptyline at the same time.  Either way, does reinstatement after a month just cause the drug to be ineffective, or does it make you have an adverse reaction?  Don't bother answering if you haven't the time, as I'm not facing this situation right now, and others need help.  Just thought many would have the same question, and perhaps there's a link to a article to make answering easy.  Thank you!

insomnia, anxiety, depression- since childhood

lyme disease, dysautonomia, chiari malformation- dx 4/1997

nortriptyline- 75mg since childhood

clonazepam- 3mg since 4/1997

trazodone-100mg since 4/2013, now tapering

rotating antibiotics and antimalarials for lyme disease

midodrine- 10mg for dysautonomia

repeated skull surgeries for chiari malformation

 

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I think it becomes a wild card after that. After two months even more unpredictable. Reinstating a tiny portion and titrating up if needed is more likely to be successful. But it does help some. In my "virgin" round of AD, I stopped several times for six weeks, had a stomach ache I thought was depression, and reinstated each time with immediate relief. But that was Prozac, with it's long half-life.

1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.

Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12

Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13

Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15

11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)

9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol

7.4.14 Started Walsh Protocol

56 years old

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Here's the topic about reinstatement, Ellen.

 

We need to think of the nervous system as dynamic. As time goes on, it adapts as well as it can to the lack of the drug on which it became dependent, and may become intolerant of that kind of interference.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 3 months later...
It looks like reinstalling can work even after 3-4 months after stopping. I will see, now it is very early to be sure.

 

I stopped Paxil at the end of last November, after a slow and long tapering. I started 2 and a half years ago at 10 mg, then 20 and then going down. It worked very well until the very end, I decreased 10-25% each time, then stabilizing for weeks (it worked for me). I had symptoms, anxiety, brain zaps, tremors, but manageable. 

 

The last drop, from 1 mg to nothing was not good. At the beginning it was fine, but after 2 months I crashed, the symptoms became unbearable. The knot in the stomach was never leaving me. I was fearing an unknown catastrophe will happen any minute. 

 

I had to reinstall at 1 mg and after one week I feel much better. 1 mg is a tiny quantity, I cut the 10mg pill in 8, and then remove some, but it can make such a difference! 

July 2011 - nasty anxiety crisis (lost job, became not functional, couldn't exit the house alone)
August 2011 - started 10mg Paxil  and October 2011 - 20mg (one month on 20mg)
November 2011 - starting slowly to decrease the dose at the pace my body supported. Down to 2.5 mg in January 2013 (17.5, 15, 12.5, 10, 7.5, 5, 3.7, 2.5) - at least one month at each step. Got a new job.
April 2013 - stopped completely, crashed after 2 weeks, and reinstalled 2.5mg, recovered fast.
September 2013 - started decreasing again, slower, down to 1 mg in December 2013
December 2013 - free of Paxil
March 2014 - another crash, exactly 3 months after stopping, after 2 weeks of horrors, reinstalled 1 mg - feeling better after one week.
March 2014 - July 2014: going slowly down: 1mg, 0.9mg, 0.77mg, 0.64mg
end of July 2014 - Paxil free, hopefully forever this time.

Jan 2024 update - Still Paxil free, feeling good. 

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  • 2 months later...

Sorry if I missed a thread that explains this, but why does reinstatement only work within one month of stopping or reducing the dose of a drug? What happens if it is reinstated later?  I'm curious if this explains why I developed serotonin syndrome when I took Celexa- to the point of having to stop it immediately. I had taken Celexa earlier in my life with no problems, but I wasn't on the trazodone and nortriptyline at the same time.  Either way, does reinstatement after a month just cause the drug to be ineffective, or does it make you have an adverse reaction?  Don't bother answering if you haven't the time, as I'm not facing this situation right now, and others need help.  Just thought many would have the same question, and perhaps there's a link to a article to make answering easy.  Thank you!

 

I had the same issue more or less.

 

I was on an SSRI, though it didn't seem to do much one way or another.  I stopped it abruptly and somehow was okay doing that.  Then months later I re-started the same drug and all of a sudden had severe problems with it. 

I am not a medical professional and nothing I say is a medical opinion or meant to be medical advice, please seek a competent and trusted medical professional to consult for all medical decisions.

 

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Reinstatement is more likely to work done fairly soon after stopping a drug, while the nervous system is still somewhat shaped around the drug that's been removed. The window of opportunity is not definitely a month, and probably varies from individual to individual, but but reinstatement is best done sooner rather than later.

 

This makes waiting to see if withdrawal symptoms will go away a difficult choice. If you wait, they may go away or you may miss your chance for effective reinstatement. (Medicine assumes withdrawal symptoms last only a few weeks; it's sign you're in for a longer period of recovery if your symptoms have not diminished over this amount of time.)

 

After a while after discontinuation, the nervous system changes and may no longer accept reinstatement of the drug to repair the withdrawal reaction. It's like a series of dominoes gradually falling over time. Hypersensitivity can set in making reinstatement very difficult, as the nervous system will react in strange ways to the original drug and often other drugs as well.

 

(A combination of Celexa with trazodone and nortriptyline can result in serotonin syndrome in anyone. If one's nervous system has been sensitized by withdrawal syndrome, this can cause disastrous adverse effects.)

 

This is why when someone has been off the drug for more than a month, we suggest trying a very low dose. Hypersensitization is so common with withdrawal syndrome, trying a very low dose initially reduces the risk of a severe adverse reaction. And quite frequently, a very low dose will work to reduce withdrawal symptoms.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Reinstating probably two or more animals. In cases where a person is taking 2 or more drugs, stops only ONE rapidly and destabilizes, reinstating would work better. In cases where a person rapidly removes all drugs, reinstating would be more of a crapshoot because taking any drug immobilizes the detox organs to some degree so stopping all drugs will create more problems due to toxin mobilization and this adds an extra layer of complexity which makes the reinstatement more unpredicatable.

 

In one case this is a good theorectical argument in support of coming off drugs one at a time rather than detoxing a group of meds more gradually and all at the same.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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alex, I'm not sure what you mean by "immobilize the detox organs."

 

When someone quits more than one drug at once and develops severe withdrawal symptoms, it's true that reinstatement is a crapshoot, in many ways. Which drug to reinstate, should it be both drugs, and at what dosages can only be guessed.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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There is evidence from Stuart Shipko that benzos immobilize the gallbladder to a degree. One part of the withdrawal syndrome of benzos is, I presume, due to a remobilization of the gallbladder once the benzos are removed after which reactive particles would be more rapidly released and these would be very damaging in the body, causing inflammation and sensitivity to sound, for instance, insomnia, and for instance and hypothetically many other symptoms. The idea is that this part of the syndrome will only kick in once the drugs are stopped entirely, I assume the antidepressants and antipsychotics all slow the liver, gallbladder or other organs to some degree by, at the least, demanding resources for their own metabolization and this causes roadblocks and results in a buildup of toxins which are released once all the drugs are removed.

 

I think one part of w/d is probably simply removing the roadblocks and allowing the organs of the body to work more effectively -- unfortunately causing an avalche of release in the 'acute' phase of the syndrome. So this part of the problem would strike only after all the drugs are removed. Removing one drug of a multi-drug regimen would not affect the terrain in this way.

 

I take this from my experience with the mold doctors who have told me repeatedly that their patients do not recover until they are able to remove the mold metabolities and this doesn't happen until the drugs are finally gone 100% at which point the mold toxins can and do come down reasonably quickly. My experience with the mycotoxin urinalysis before and after my final d/c supports this and if it is true that rapid toxin release from GB and liver occurs after d.c then I have to think all cases would be affected by toxin release to some degree.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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I think you and other members who have co-existing conditions such as parasites, mold infection, Lyme disease, etc. have special problems that might be related to organ functioning.

 

But for most people, going off psychiatric drugs is more likely to cause nervous system destabilization rather than organ malfunction. I don't think the liver or gall bladder become dysfunctional and there is no issue with toxins being released -- it's a gradual, natural body function.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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To some degree the nervou system remains dysfunctional for so long because of the presence of a roadblock. If I imagine a roadblock of a physical kind it makes more sense to me why recovery can take so long. I only really know for me and my case though but I think theoretically the argument is strong for some factor like this as a part of every case. Also the toxins aren't the drugs or anything to do with the drugs, necessarily. The regular toxins of everyday life back up. This should be measurable actually but it's outside the mainstream of medicine and otherwise costly.

 

The main point, in the context of this topic, is that if toxin release plays a role in this syndrome the issue would only be unleashed after all the drugs were removed. So that if a person crashes after removing one benzo and is still on, say, a Zdrug, an SSRI and an SNRI, then it's fair to think their w/d symptoms are unrelated to this mechanism because in theory the eliminative organs are still backed up.

 

This is speculation on my part. Someday I may try to solve this part of this issue myself for other people who are suffering, depending on my own outcome, because I have tons of specialized experience in this area.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Correct, my parenthetical comment was on Ellen's post.

 

Alex, nervous system dysfunction is undeniably a problem in withdrawal syndrome and treating withdrawal syndrome. However, I disagree with your theory that going off all psychiatric drugs unleashes toxins. There are dozens and maybe hundreds of liver enzymes. While a drug might preoccupy one or more, the others are still working. The liver has multiple avenues of detoxification, as do the other organs.

 

I  can't extrapolate from what Dr. Shipko said, perhaps you can contact him and ask him to elaborate in regards to a case such as yours, in which going off drugs seemed to make you susceptible to opportunistic infection.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 1 month later...

In my experience, each time I decrease the dose, I have some symptoms. The decision to updose or reinstate depends entirely on the severity of the symptoms. Brain zaps, tinnitus, lighthead, uncomfortable in my own skin, waking up trembling, all this I can bear. But when the dizziness doesn't allow me to go to work, the fear is so extreme, I don't want to exit the house, I am continuously tense or crying, then I know I did it too fast, and I have to go back to the last dose.

July 2011 - nasty anxiety crisis (lost job, became not functional, couldn't exit the house alone)
August 2011 - started 10mg Paxil  and October 2011 - 20mg (one month on 20mg)
November 2011 - starting slowly to decrease the dose at the pace my body supported. Down to 2.5 mg in January 2013 (17.5, 15, 12.5, 10, 7.5, 5, 3.7, 2.5) - at least one month at each step. Got a new job.
April 2013 - stopped completely, crashed after 2 weeks, and reinstalled 2.5mg, recovered fast.
September 2013 - started decreasing again, slower, down to 1 mg in December 2013
December 2013 - free of Paxil
March 2014 - another crash, exactly 3 months after stopping, after 2 weeks of horrors, reinstalled 1 mg - feeling better after one week.
March 2014 - July 2014: going slowly down: 1mg, 0.9mg, 0.77mg, 0.64mg
end of July 2014 - Paxil free, hopefully forever this time.

Jan 2024 update - Still Paxil free, feeling good. 

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  • 5 months later...

"Once the nervous system is destabilized by withdrawal, all bets are off."

 

Wow this is the exact conclusion i had come to and had said a very similar thing on another site....my words were "once the wdl nightmare is triggered its very difficult to reign it back in and all bets are off the table" I have likened it also to trying to back the car up the freeway off ramp ...not an easy thing to do.

 

This thread is incredibly informative. 

 

Thankyou so much for this truly insightful info.

This conundrum has really been on my mind over the last year and had me at a loss as to how to attack it.

 

It has really been a dilemma for me as to what to suggest to help a person who has tapered too fast ...as one does  ...doctors are just clueless idiots....and then observe them watching the fish flap around on the beach for a week oblivious to the incoming wdl tsunami.

The difficulty is most cannot hang around very long on a small dose when all hell breaks loose...the suffering is too much.

I previously couldnt understand why rec going on at a low dose is useful when surely getting back in the bunker would be best when getting carpet bombed. Not many people can absorb this for very long. It also brings many voices to the table as to what is the best game plan. It really is a most dreadful place to be in.

 

I often thought the best bet could be to go back on at the dose one would have been on had they been doing the 10% taper ...if you know what i mean .

 

This has given me a lot to think about ...wow !! I am always prepared to change my thinking when presented with good evidence to do so. Thanks.

Best thread i have read so far!

Beginning to like this site more and more.

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Yes, going back on a drug after years is a crap shoot -- as in the gambling dice game, craps http://en.wikipedia.org/wiki/Craps

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Oh ...how stupid of me ...I thought it might have something to do with shooting a piece of cow dung and sh*t goes everywhere....well what ya know...this country boy from nz learns something new everyday!

 

So what I think you are implying is 'crap shoot' .... means  the odds of a win are heavily loaded against you, ie the house always wins !

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Don't think it's quite like that Mark.  It's not so much heavily weighted against you, it's more that you just don't know.   Anything can happen - you roll the dice and take your chances. 

 

I've re-instated dozens of times over the past decade or so - gone from zero back to 20mg many times.   Been off for more than a year and gone back on.  No problems at all.   I wouldn't do it again (not back to 20mg anyway) - I now realise how lucky I've been so far, but I've just successfully re-instated yet again after more than two months off and feeling great now.   

Put on Prothiaden for severe depression in 1989.  Recovered.   Prescribed Paxil for another bout of depression around 2000.   Have been trying to taper ever since but always crash about 2 months after getting to zero.   Because of the crashes, for years I thought that there was something wrong with me.   Then found that the crashes were simply withdrawal.   Now following a maximum of a 10% reduction every month or so and ready to slow down any time I feel any symptoms whatsoever.  Feeling good:).

7th Jan 15 - 3.6mg

28th Jan 15 - 3.2mg

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We see lots of people here do better with reinstating, but some do not. It's unpredictable.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 4 weeks later...
  • Moderator Emeritus

Hey Alto and CW,

 

I'm trying to get some info straight about stuff that I have read on this site. In one of the reinstatement threads, actually I think it might be a thread about what to expect from your doctor, it says that you need immediate medical attention if you're experiencing severe withdrawal symptoms. It also says reinstatement of a partial dose and slow tapering is the standard in psychiatric care.

 

But I've seen in other places on here where it says reinstatement is no guarantee and could actually make things worse, especially if some time has gone by and especially when there are movement symptoms involved.

 

How can a new person sort through that information and decide what to do?

 

How long is considered generally too long to reinstate?

 

What are the risks of severe withdrawal on a slow taper?

 

If the person had side effects while on the med, is reinstatement advised anyway?

*I'm not a doctor and don't give medical advice, just personal experience
**Off all meds since Nov. 2014. Mentally & emotionally recovered; physically not
-Dual cold turkeys off TCA & Ativan in Oct 2014. Prescribed from 2011-2014

-All meds were Rxed off-label for an autoimmune illness.  It was a MISDIAGNOSIS, but I did not find out until AFTER meds caused damage.  All med tapers/cold turkeys directed by doctors 

-Nortriptyline May 2012 - Dec 2013. Cold turkey off nortrip & cold switched to desipramine

-Desipramine Jan 2014 - Oct. 29, 2014 (rapid taper/cold turkey)

-Lorazepam 1 mg per night during 2011
-Lorazepam 1 mg per month in 2012 (or less)

-Lorazepam on & off, Dec 2013 through Aug 2014. Didn't exceed 3x a week

-Lorazepam again in Oct. 2014 to help get off of desipramine. Last dose lzpam was 1 mg, Nov. 2, 2014. Immediate paradoxical reactions to benzos after stopping TCAs 

-First muscle/dystonia side effects started on nortriptyline, but docs too stupid to figure it out. On desipramine, muscle tremors & rigidity worsened

-Two weeks after I got off all meds, I developed full-blown TD.  Tardive dystonia, dyskinesia, myoclonic jerks ALL over body, ribcage wiggles, facial tics, twitching tongue & fingers, tremors/twitches of arms, legs, cognitive impairment, throat muscles semi-paralyzed & unable to swallow solid food, brain zaps, ears ring, dizzy, everything looks too far away, insomnia, numbness & electric shocks everywhere when I try to fall asleep, jerk awake from sleep with big, gasping breaths, wake with terrors & tremors, severely depressed.  NO HISTORY OF DEPRESSION, EVER. Meds CREATED it.

-Month 7: hair falling out; no vision improvement; still tardive dystonia; facial & tongue tics returned
-Month 8: back to acute, incl. Grand Mal seizure-like episodes. New mental torment, PGAD, worse insomnia
-Month 9: tardive dystonia worse, dyskinesia returned. Unable to breathe well due to dystonia in stomach, chest, throat
-Month 13: Back to acute, brain zaps back, developed eczema & stomach problems. Left leg no longer works right due to dystonia, meaning both legs now damaged
-7 years off: Huge improvements, incl. improved dystonia

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1. How can a new person sort through that information [ri] and decide what to do?

 

2. How long is considered generally too long to reinstate?

 

3. What are the risks of severe withdrawal on a slow taper?

 

4. If the person had side effects while on the med, is reinstatement advised anyway?

Everyone else must be asleep so i'll be cheeky and put some cards on the table and we'll see how they fall.

 

1. A new person can put up their drug signature and details, taper history and people can then point them in what has shown to be the best observed direction. A new person needs to spend time reading this stuff to get up to speed on the true informed place they now find themselves in. And if they value their health and desire to take responsibility for it, instead of blindly trusting the doc then they owe it to themselves to spend this time. A too fast taper triggering the wdl nightMARE to bolt puts a person in a place where 'all bets are off ' as to how to resolve it. Ri at a low dose is the first preferred option of this site, other options are listed in the thread about this. This is not an exact science so no one knows whats going to happen until you try an option.

 

2. How long is a piece of string? Its been shown a ri as soon as possible is best ...i think 2 months is  starting to get a tricky time. Having said that i know of people who have ri after 11 months off and stabilize ok and then gone on to taper off successfully (mapleleafgirl). So really there is no set rules imo. But sooner is better.

 

3. The risks of severe  wdl symptoms on a slow taper (10% ) are hopefully minimised. This is a rate that has been proven to be successful/provide the best chance  in getting people off the drug.  However lets be clear on something ..despite a slow taper even 5% there is no guarantee of zero wdl symptoms. But hopefully it should make them short in duration and manageable allowing one to have a life while tapering. You are going to have to absorb some  wdl no matter what rate you taper imo. One can listen to their body and know whats happening and slow the taper even more. Starting slow is key. Then if the coast is clear you can proceed.

 

4.  What side effects are you referring to? If you have done a fast taper ...as basically we all have because our doctors are clueless ...and you cant cope drug free and are starting to use the 's' word then i think you have no option regardless, but to ri and try to stabilize. imo. If you are referring to pregnancy then that is a curly one and i don't know what call to make, as a clueless mere male, except to say maybe  the health of the mother would be paramount. But others wiser than me could better advise.

 

Well its time for me to join the rest of the world and go to sleep. That's my 2 cents worth in the meantime you'll just have to wait until the mods arise and shine. Mind you there should be some Aussies awake at this time...they are 2 hours behind us....actually come to think of it Aussie 's are behind Kiwis in a lot of ways really... ..

Goodnight.

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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I think I know the answer to this from all the reading I've done here, but I'll ask anyway. If you reinstate but show no improvement in say, 3 weeks (or 4 or whatever), you then still have to taper off that low dose to avoid making withdrawal even *worse*, right? 

Started Zoloft 07/06, continued through 07/08 (2-month taper, going downhill 6 weeks after stopping [w/d?]) 

Lexapro started 12/08, Lexapro increased/Buspar and Topamax added in '09, continued through 08/10 (3-month taper, disastrous results after 3 week [w/d?]) 

200 mg Zoloft started around 9/10; been between 150 and 200 mg Zoloft since then, also on Topamax and Deplin, and tried things for sleep like Trazadone (worked for a while), and Ambien, Lunesta, and Mirtazapine (all failed) 

--Started tapering 200mg Zoloft--

6-26-14 (150 mg); 7-14-14 (100 mg); 8-20-14 (50 mg); 10-25-14 (25 mg); 11-18-14 (12.5 mg); 12-2-14 stopped Zoloft 

anxiety started 3 days off, depression 12 days off; both severely intensified at 5 weeks off with a work-related trigger and got progressively worse for 10 days 

Reinstated Zoloft 12.5mg on 1-15-15 (one day at 25mg) after 6 weeks and 2 days off 

Also taking 100mg Topamax and 15mg Deplin 

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nz has got it! 41.gif

 

I have tried to explain reinstatement as clearly as possible in #1. It's pretty simple, really: It's trial and error, which is how these drugs have been prescribed all along.

 

The window in which reinstatement is effective is not defined. The assumption behind "immediate medical attention" when withdrawal symptoms surface is that withdrawal symptoms occur quickly after discontinuation. In other words, reinstatement should be done within a couple of weeks of quitting. However, we know that withdrawal symptoms can be delayed, so we recommend reinstatement as soon as possible.

 

I think the confusion is because we *expect* that taking a drug is going to work, we *expect* words like "always" and "guaranteed". it's hard to accept it that there is no certainty when it comes to psychiatric drugs and never was.

 

Also, doctors and the general public have the idea that "more is better", but now we're in a territory where more might be worse and we have to avoid it with a cautious exploratory partial dose when attempting reinstatement.

 

Now, given another principle -- to keep your nervous system as stable as possible and avoid big drug changes -- even if your reinstatement has lasted a short time, you would want to go off gradually. Maybe not as gradually as 10% per month, but a fast taper. You might want to try a 10% reduction to start, in case your nervous system has already become dependent on the drug even though you don't feel any effects.

 

If you have adverse effects from the reinstatement, which you should track by taking notes of your daily symptom pattern Keep Notes on Paper, in case they're from something else, you will want to go off faster. This is a case-by-case consideration to be done in your Introductions topic, not in this topic, because such detailed discussion will take it off track and make this topic difficult for others to follow.

 

If you had adverse effects from the drug when you were on it and are suffering withdrawal symptoms, reinstatement could be tried at a low, partial dose. Side effects are dosage-related: Lower doses incur fewer side effects. The adverse effects you felt on the drug indicate it was probably always too high a dose for you (or wrong for you entirely).

 

It is possible that at a low dose, you can reduce withdrawal symptoms and not suffer the adverse effects you suffered before. Again, this depends on the adverse effects and your current symptom pattern, another case-by-case consideration to be done in your Introductions topic.

 

What do we mean by a partial, low dose? You may notice we often suggest trying reinstatement of antidepressants at doses as low as 1mg-5mg, particularly if someone has been off the drug for more than several weeks. Believe it or not, people have found relief at those low doses and then tapered off successfully later.

 

However, since drugs are dosed at different levels, a partial, low dose of another drug, such as Abilify, might be 0.25mg, or of Neurontin, 10mg. Since people are on different drugs, the dosing is another case-by-case consideration to be done in your Introductions topic.

 

Edited by ChessieCat
Added Keep Notes on Paper Link and made Abilify 0.25 easier to see dose

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Alto, I know you have written it's on a case by case basis so maybe I'm just being a bother, but, I could swear I read off-site that in cases where people have TD issues come out while on the drug RI doesn't work, at least to cover over the TD.  Are there people here who had TD-like symptoms on the drug who reinstated successfully?

 

If I did read that it would have been about antipsychotics, since the bulk of what is written about TD focuses on them.

 

If someone developed tardive dyskinesia while on a drug, I would be wary of reinstating it.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 7 months later...

So I am almost a week stabilized after 3 months of a double dose of reinstatment A

 

it was like a switch just flipped on Tuesday and bam I feel normal! I still have ringing in my ears, some side effects, a little anxiety but all of these things are before and after medication symptoms so I would not say they are wd related.

 

My doc really wanted me to switch meds- she said the Paxil was no longer working- I can't say I will be like this in an upward feeling of normalcy without anymore waves; I don't discount that I will probably have some, but it really is a huge difference; I think patience is the key with reinstatment (imo) as alto says our cns is unstablized and it needs stability.

 

So just wanted to post my experience here; and I hope my bad wd experience has prepared me for anything I might face when I begin to taper next year.

Edited by scallywag
inserted paragraph breaks

 

*Currently at 8.2-8.5 mg of my 10mg pill of Paxil (they actually weigh 12.5mg) 

january 2023 I began reducing my med again. I was a 9mg weight for years, I went to 8.9 in January, went to 8.6mg in February, and in March 2023 I went down to 8.5-8.2 mg ( my scale varies, so I stick within that .3 range because of that) 

*No other supplements or vitamins 

*Taper schedule in the pdf 

Blank.pdf

 

https://docs.google.com/document/d/1-5vShtJtwAOGA30OxIP87steLmMdFzD29F0fzAPD564

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  • 1 month later...

Alto posted earlier in this thread:
 
 

 

Reinstatement is more likely to work done fairly soon after stopping a drug, while the nervous system is still somewhat shaped around the drug that's been removed. The window of opportunity is not definitely a month, and probably varies from individual to individual, but but reinstatement is best done sooner rather than later.This makes waiting to see if withdrawal symptoms will go away a difficult choice. If you wait, they may go away or you may miss your chance for effective reinstatement. After a while after discontinuation, the nervous system changes and may no longer accept reinstatement of the drug to repair the withdrawal reaction. It's like a series of dominoes gradually falling over time. Hypersensitivity can set in making reinstatement very difficult, as the nervous system will react in strange ways to the original drug and often other drugs as well. This is why when someone has been off the drug for more than a month, we suggest trying a very low dose. Hypersensitization is so common with withdrawal syndrome, trying a very low dose initially reduces the risk of a severe adverse reaction. And quite frequently, a very low dose will work to reduce withdrawal symptoms."

 
 
Colonial:  I have Never dropped below 10mgs of Paxil.  Which is well below therapeutic levels but, as I remember from the SERT curve study, is still enough to re-wire around 75% of your brain receptors.
 
So while I have been at this level almost 4 months do you think that since I never dropped below the 10mgs I may have better luck with "reinstatement" if the doctor wants me back up at higher doses?  I realize these studies are usually done on "virgin" brains, and after dropping down to 10mgs from being at 25 for almost 22 years, what my brain "looks" like may be different, but could there may be some "positive" news to having never dropped below that 10mg level for reinstatement purposes?

Edited by scallywag
moved quote to a quote box for clarity

 Starting ds 2 (12.5 CR'S) = 25 MG PAXIL CR 1/21/15: 1 Pill + 10mg liquid (2 weeks) 2/4: 1 Pill + 9mg Lq (3 weeks) 2/25: 1 Pill + 8 mg lq (1 week) 3/4: 1 Pill + 6 mg lq (2 weeks) 3/18/15 1 Pill + 4 mg lq (2 weeks) 4/1/15 1 Pill + 3 mg lq (2 weeks) 4/14/15 1 Pill + 2 mg lq (2 weeks) 4/29/15 1Pill + 1 mg lq (16 days) 5/15/15 1 12.5 mg Pill ONLY (9 days) 5/24/15 12 mgs liquid (8 days) 6/1/15 11mg lq (12 days) 6/13/15 10 mg.  12/3/15 Drop from 8mg to 7.6 (24 days to) 12/27/15 7.2mgs 8/4/16 6.8mgs,  11/1/16 6.4mgs, 2/5/17 6 mgs  4/3/17 5.6mgs, 4/24/17 5.2mg, 6/13/17 4.8mgs, 9/20/17 4.4mgS, 11/23/17 4 mgs, 1/1/18 3.6 mgs, 2/15/18 3.2 mgs. 4/13/18 2.8mgs, 5/11/18 2.4mgs, 6/10/18 2.0 mgs, 8/4/18 1.6mgs,  9/27/18 1.2mgs, 12/24/18 0.8mg, 3/24/19 0.64 mg,(syringe change issue date?) 4/22/19 0.60 mg, 5/24/19 0.60 mg, 7/7/19 0.52 mgs, 8/4/19 0.44mgs, 11/4/19 0.36mgs, 2/1/20 0.28mgs, 3/1/20 0.24mgs (crash April 6) Compound started 6/28/21: 0.24mgs, 8/29/21: 0.22mgs, 10/31/21: 0.20mgs, 1/03/22: 0.18mgs, 3/5/22: 0.16mgs, 5/5/22: 0.14mgs.

 

Original Wellbutrin Dose: 6 months from 9/14 to 3/2015, 300 XL 3/15/15: Half to 150 XL ( severe symptoms started on day 12) 4/16/15: 125mg   for 20 days to: 5/6/15:   100mg  for  15 days to: 5/21/15    75mg  for  10 days to: 6/1/15:  56.25mg      13 days to: 6/13/15: 37.25mg    7 days to: 6/20/15  28.12mg   14 days to: 7/4/15  18.75mg, 7 days to: 7/11/15; RAISE BACK TO: 28.12 to 8/14/15: 18.75mg  20 days to :9/3/15 : 12.5mg, 8/4/16 9mg 1/9/17: 8.5mg 2/8/17 8mg, 3/9/17: 7.6  4/9/17  7.2  5/27/17 6.4 6/24/17 5.8, 8/1/17 5.0, 8/29/17 4.2mgs, 10/2/17 3.5mgs, 12/28/17 2.5mgs, 2/27/18 1.7mgs,  4/19/18 0.8 mgs, LAST DOSE: 6/11/18:  3 YEARS, 2 MONTHS, 27 DAYS...

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If you've suffered withdrawal symptoms at any dosage, your nervous system may be sensitized to all psychiatric drugs.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 4 weeks later...

hello I haven't posted on this site before but i used it regularly in my withdraw.  I was on medication since i was 18 years old and stopped when i was 31.  My last medication was lexapro, I slowly tapered myself down for an entire year.  The last day was hell i suffered from unrelenting dp/dr suicidal thoughts inability to put sentences together i suffered med free for 16 months, I couldn't read or listen to music i couldn't even go outside without suffering major dp.  I was afraid to drive and had thoughts that would enter my mind out of nowhere to go drive off a bridge.  I would see evil faces on people out of the corner of my eye that really scared me.  needless to say i was a mess.  I worried my family and nearly drove my very loving girlfriend into a break up.  I went to every doctor and had every test known to man.

I finally landed my dream job and was scared to death to take it.  my anxiety dp d/r was so great i decided to go to the doctor. and was prescribed 25mg zoloft i read so many post saying it would never work and it would just make things worse. i was very anti medication and i believed i was a lost cause i believed what i read on here and made it true in my mind that i was hopeless.  thankfully Thats not my experience. I have been on zoloft now for two months the first two weeks were classic when starting an ssri increased anxiety etc.  I am currently a different person I am a firefighter like i always dreamed of and worked so hard pre withdrawal. my dp is 99% gone and my depression is about 70 % better. I can concentrate as well as listen to music. I'm not 100% but reinstatement WORKED for me it changed my life.  I am ok with being on medication again I have my life back. my girlfriend is very happy and it still brings tears to my parents eyes when i call and say "im doing good mom"  because for so long that was not the case  My mother and father have their son back and my brothers have their big brother back! i know this is an anti medication web site i just felt compelled to reach out to those on the brink of suicide I was there i had no quality of life and yes if taking medication pulls me back from the ledge and gives me a quality of life that i didn't have before then so be it .good luck to all and find your own path. Don't give up      THERE IS HOPE!

Edited by KarenB
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Reinstating is the only way medicine knows to reduce withdrawal syndrome, you've gotten decent advice there. Quite often, we see it works.

 

Needing to reinstate does not mean you have a "mental illness" -- that doctor was wrong. It means you tapered too fast and you need to taper slower.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Hopefully my experience will help someone.

I tapered from 5mg of Lexapro too fast. Like most was just following what dr was saying. I cut to 2.5 then to 1.25. I never made it to zero. I made it to 0.625mg. I was in severe withdrawal.

Reinstated to 5mg while never reaching 0, also on doctors advice. It made everything worse and totally destroyed my sleep. I waited for 2 months at 5 but couldn't stabilize.

10/2012 - Lexapro 10mg

2013/2014 - Started experiencing visual disturbances, like visual processing was slow, feeling drunk all the time

9/2014 - Lexapro 5mg, didn't notice any withdrawal, drunk feeling went away

2015 - Drunk feeling came back

5/2015 - Lexapro 2.5mg - 1.25mg - insomnia started

6/2015 - Lexapro 0.625mg

7/2015 - Severe symptoms started, in desperation on advice of pdoc restarted 5mg Lexapro - total disaster

8/2015 - Lexapro 5mg, disoriented, sleepless zombie

9/2015 - Very reluctantly started transitioning to Zoloft

as of 10/10/2105 - no lexapro, 37.5mg Zoloft

12/14/2015 - 35mg zoloft, 1/16/2016 - 34mg

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startcontrol, i have similar experience.... a couple of days ago i updosed from 4mg to 5mg and it triggered new symptoms to me. :( Before my symptoms were so much easier compared to this all i had was tiredness and muscle weakness so that i was housebound, and nausea( on and off),  but now i have also terrible insomnia, constant restlessness,  and my eyes are sore. If i could i would undo that updosing...

 

i would really like to hear how long has it took for those of you who has updosed with bad reaction to stabilize? please i need some hope... 

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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  • 2 weeks later...

I also updosed during a too fast taper and everything got really really bad! I waited for 5 months to stabilize before I started reducing again; only now after 2 months of reducing do I have Windows where I feel normal! They come ever 9-12 days but during those windows I feel so much better, more hopeful

 

My advice, if your symptoms got worse after an updose, don't wait 5 months; start shaving your pill; I was in pure and utter despair;

 

My updose made things so much worse

 

*Currently at 8.2-8.5 mg of my 10mg pill of Paxil (they actually weigh 12.5mg) 

january 2023 I began reducing my med again. I was a 9mg weight for years, I went to 8.9 in January, went to 8.6mg in February, and in March 2023 I went down to 8.5-8.2 mg ( my scale varies, so I stick within that .3 range because of that) 

*No other supplements or vitamins 

*Taper schedule in the pdf 

Blank.pdf

 

https://docs.google.com/document/d/1-5vShtJtwAOGA30OxIP87steLmMdFzD29F0fzAPD564

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